TEST REPORT Ordering Provider: David Getuwell, MD 8605 SW Creekside Place Beaverton, OR 97008 Phone: 503-466-2445 Fax: 503-466-1636 Samples Received 08/15/2018 Report Date 08/20/2018 Samples Collected Saliva - 08/12/18 07:40 Saliva - 08/12/18 12:00 Saliva - 08/12/18 18:00 Saliva - 08/12/18 22:00 Blood Spot - 08/12/18 07:40 Patient Name: Patient Phone Number: 555 555 5555 Gender Male DOB 11/29/1983 (34 yrs) Height 5 ft 7 in Weight 160 lb Waist 31 in BMI 25.1 TEST NAME RESULTS 08/12/18 RANGE Salivary Steroids Estradiol <0.5 L 0.5-2.2 pg/ml Testosterone 81 44-148 pg/ml (Age Dependent) DHEAS 12.4 2-23 ng/ml (Age Dependent) Cortisol 11.8 H 3.7-9.5 ng/ml (morning) Cortisol 6.3 H 1.2-3.0 ng/ml (noon) Cortisol 1.3 0.6-1.9 ng/ml (evening) Cortisol 0.5 0.4-1.0 ng/ml (night) Blood Spot PSA 10.8 H <0.5-4 ng/ml (optimal 0.5-2) Blood Spot Thyroids Free T4* 1.6 0.7-2.5 ng/dl Free T3 3.3 2.4-4.2 pg/ml TSH 1.2 0.5-3.0 µu/ml TPOab* 16 0-150 IU/mL (70-150 borderline) <dl = Less than the detectable limit of the lab. N/A = Not applicable; 1 or more values used in this calculation is less than the detectable limit. H = High. L = Low. * For research purposes only. Therapies None 1 of 5
TEST REPORT Results continued Graphs Disclaimer: Graphs below represent averages for healthy individuals not using hormones. Supplementation ranges may be higher. Please see supplementation ranges and lab comments if results are higher or lower than expected. Average Off Graph 200 Saliva Testosterone 30 Saliva DHEAS 175 150 125 25 20 pg/ml 100 ng/ml 15 75 50 25 10 5 0 10 20 30 40 50 60 70 80 90 100 Age 0 10 20 30 40 50 60 70 80 90 100 Age 12 Saliva Cortisol 10 8 ng/ml 6 4 2 03:00 06:00 09:00 12:00 15:00 18:00 21:00 00:00 03:00 Time of Day 2 of 5
TEST REPORT Patient Reported Symptoms Disclaimer: Symptom Categories below show percent of symptoms self-reported by the patient compared to total available symptoms for each category. For detailed information on category breakdowns, go to www.zrtlab.com/patient-symptoms. SYMPTOM CATEGORIES RESULTS 08/12/18 Estrogen / Progesterone Deficiency 10% Estrogen Dominance / Progesterone Deficiency 3% Low Androgens (DHEA/Testosterone) 23% High Androgens (DHEA/Testosterone) 21% Low Cortisol 35% High Cortisol 31% Hypometabolism 26% Metabolic Syndrome 13% SYMPTOM CHECKLIST MILD MODERATE SEVERE Acne Aggressive Behavior Allergies Anxious Apathy Blood Pressure High Blood Pressure Low Blood Sugar Low Body Temperature Cold Bone Loss Burned Out Feeling Chemical Sensitivity Cholesterol High Constipation Depressed Dizzy Spells Erections Decreased Fatigue - Evening Fatigue - Mental Fatigue - Morning Flexibility Decreased Forgetfulness Increased Goiter Hair - Dry or Brittle Hair or Skin Oily Headaches Hearing Loss Heart Palpitations Hoarseness Hot Flashes Infertility Irritable Joint Pain Increased Libido Decreased Mental Sharpness Decreased Muscle Size Decreased Muscle Soreness Nails Breaking or Brittle Neck or Back Pain Nervous Night Sweats 3 of 5
TEST REPORT Patient Reported Symptoms continued SYMPTOM CHECKLIST MILD MODERATE SEVERE Numbness - Feet or Hands Prostate Cancer Prostate Problems Pulse Rate Slow Rapid Aging Rapid Heartbeat Ringing In Ears Skin Thinning Sleeping Difficulty Stamina Decreased Stress Sugar Cravings Sweating Decreased Swelling or Puffy Eyes/Face Triglycerides Elevated Urinary Urge Increased Urine Flow Decreased Weight Gain - Breast or Hips Weight Gain - Waist Lab Comments Estradiol is low, which is common and expected in young men, particularly with low body fat. While lower levels of estradiol are normal in young men, very low levels can be caused by low testosterone (testosterone is an estradiol precursor) or medications (aromatase inhibitors often used in men on testosterone therapy) that inhibit the enzyme aromatase that converts testosterone to estradiol. Adequate levels of estradiol, in both men and women, is essential for optimal bone and brain health. Very low estradiol can lead to bone loss and increased fracture risk, which is more problematic in older thin men. Testosterone is within mid-normal range. In healthy males from youth to middle age testosterone levels usually range from about 80-120 pg/ml. Healthy testosterone levels drop to about 60-80 pg/ml in men > 60 years of age. Supplementation with physiological amounts of androgens usually raises testosterone to levels seen in young men. Testosterone ranges are age specific. Normal age-dependent testosterone levels are usually associated with few symptoms of androgen deficiency, however, in some individuals with other hormonal problems (e.g. low IGF1, low thyroid, low or high cortisol) symptoms can be similar to androgen deficiency. DHEAS is high-normal for the expected age range. DHEAS is highest during the late teens to early twenties (10-20 ng/ml) and drops steadily with age to the lower end of range by age 70-80 (2-9 ng/ml). High-normal age-range DHEAS levels are common in well trained athletes and individuals supplementing with DHEA or adrenal adaptogens that stimulate adrenal production of DHEA. High DHEAS may be associated with high androgen symptoms (loss of scalp hair, increased facial/body hair, acne). Cortisol levels are high in the morning and at noon and fall to within range in the evening and at night. High cortisol levels in the morning and at noon may suggest an acute stressor or use of a corticosteroid-containing medication (e.g., prednisone, steroid inhaler, topical hydrocortisone). High cortisol production by the adrenal glands is a normal response to stress and is essential for health; however, if the stress is chronic and adrenal cortisol output remains high throughout the day and over a prolonged period of time (months/years), excessive breakdown of normal tissues (muscle wasting, thinning of skin, bone loss) and immune suppression can result. A persistently elevated cortisol, particularly if it is elevated throughout the day or high at night, is associated most commonly with symptoms of sleep disturbances, hot flashes and night sweats (even with normal estrogen levels), fatigue, depression, weight gain in the waist, anxiety and bone loss. High cortisol can impair the actions of other hormones such as insulin, leading to insulin resistance/metabolic syndrome (associated with weight gain in the waist, unhealthy blood lipids, high blood pressure). In addition, elevated cortisol can affect the action of thyroid hormones at the cellular level, leading to thyroid resistance despite normal thyroid hormone levels. Therefore, when cortisol levels are persistently high, other hormones (estrogens, androgens, insulin, thyroid) can be within normal range, or even high, yet symptoms indicate deficiency. Adequate rest and sleep, gentle exercise, meditation, proper diet (adequate protein), bio-identical progesterone, adrenal extracts, and nutritional (vitamins C and B-complex) and herbal supplements are some of the natural ways to help support adrenal function. Recommended reading: "Adrenal Fatigue: The 21st Century Stress Syndrome" by James L. Wilson, ND, DC, PhD; "The Cortisol Connection" by Shawn Talbott, PhD; "The End of Stress As We Know It" by Bruce McEwen.; "Awakening Athena" by Kenna Stephenson, MD. PSA (Prostate Specfic Antigen) is higher than the range of < 4 ng/ml and the optimal range of < 2 ng/ml (level retested and confirmed). A high PSA is usually caused by BPH (Benign Prostatic Hypertrophy), prostate cancer, prostate inflammation or infection, and prostate or perineal trauma. Ejaculation within 48-72 hr of blood collection may also cause a slight elevation in PSA. Prostate surgery can cause a significant rise in PSA outside the normal range and testing for PSA is not recommended for at least three weeks post surgery. Periodic repeat testing for PSA is recommended. 4 of 5
TEST REPORT Comments continued Thyroid hormones (free T4, free T3, TSH) and thyroid peroxidase antibodies are within normal ranges; however, this does not exclude the possibility of a "functional" thyroid deficiency caused by other hormonal imbalances such as excess estrogen, low progesterone, low testosterone, low or high cortisol, and low growth hormone (IGF-1). Testing for these hormones and correcting any abnormalities is recommended to optimize thyroid function and minimize any symptoms, should they be problematic. 5 of 5